Individual
MR. CHARLES B PRUITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6191 CROOKED CREEK DR, REX, GA 30273-5008
(404) 414-3664
Mailing address
4061 N HENRY BLVD, SUITE E, STOCKBRIDGE, GA 30281
(404) 629-7378
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103K00000X
Behavior Analyst
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TA0700X
Adult Development & Aging Psychologist
—
—
103TB0200X
Cognitive & Behavioral Psychologist
—
—
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
103TP0016X
Prescribing (Medical) Psychologist
—
—
103TP2701X
Group Psychotherapy Psychologist
—
—
104100000X
Social Worker
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
106S00000X
Behavior Technician
—
—
Other
Enumeration date
02/10/2009
Last updated
04/22/2024
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